Shammah physiotherapy and chiropractic Kakamega

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Lumbar Disc Herniation
by Marshall Berkeley
Description
Lumbar disc herniation is the result of the nucleus proposus rupturing through the annulus fibrosus and compressing on the spinal nerve, causing low back and/or leg pain. Upwards of 80 percent of the population will experience low back pain at some point in their lives.1 Lumbar disc herniations are one of the main causes of low back pain. The following information will provide you with all the details necessary to gain a better understanding of the condition.

Anatomy
The lumbar spine consists of five vertebrae. Located between each of the five vertebrae are intervertebral discs. The discs are flexible and act as shock absorbers for the spine. The intervertebral discs are made up of two components: the annulus fibrosus and the nucleus proposus. The annulus fibrosus is the tough outer ring of the disc, and the nucleus proposus is the soft, gel-like substance in the middle of the disc. Located posteriorly to the intervertebral discs is the spinal canal in which the spinal cord passes through. At each level of the lumbar spine, nerve roots exit the spinal canal through intervetebral foramina on both sides

Incidence/Prevalence
Lumbar disc herniations are one of the most common causes of low back pain and occur 15 times more than cervical disc herniations. The peak occurrence is between the ages of 25-40.3 Males are affected more than women by a ratio of 3:2. About 90% of all lumbar disc herniations occur between the fourth and fifth lumbar vertebrae and fifth lumbar vertebrae and sacrum.4

Clinical Presentation
A patient with a lumbar disc herniation will complain of low back pain and sometimes pain in one or both of the legs. Most often, pain is reported on only one side of the low back and is considered a dull ache, burning pain, electric shock, or tingling sensation. The patient will not be able to sit for prolonged periods of time before they have to get up. Sneezing, coughing, and laughing will increase the pain. Leg pain, or sciatica, is common and will be located in the back of the thigh, calf, and/or foot depending on the extent of the nerve involvement. Numbness and weakness in the leg or foot may also be present. In serious cases, bowel and bladder control can be lost.

Potential Etiologies
Lumbar disc herniations can occur as a result of direct trauma or gradual degeneration over time. There are also several risk factors that can lead to a lumbar disc herniation.1,2 These include:

Gender (males more susceptible than females)
Poor lifting technique (bending over and not using legs to lift)
Poor posture (puts increased stress on lumbar spine and discs)
Repetitive activities (jobs involving bending, twisting, lifting, or pulling)
Frequent driving (sitting for long periods of time plus the vibration of engine)
Sedentary lifestyle (lack of physical activity & poor nutrition lead to poor disc health)
Overweight (puts more pressure on discs)
Smoking (decreases oxygen supplied to discs)
Diagnostic Tests
Magnetic Resonance Scan
Computed Tomography (CT) scan
Myelogram
Electromyography (EMG)
Nerve Conduction Velocity (NCV) test
X-ray
Evaluation/Special Orthopedic Tests
Straight Leg Raise or Slump Test to determine if neural tension is present
Neurological exam if pain, numbness, or tingling is present in leg(s)6
Conservative Treatment
Rest: important to avoid bending forward and lifting heavy objects
Nonsteroidal anti-inflammatory drugs (NSAIDs): for pain relief
Physical therapy: emphasis on core stabalization exercises
Robin McKenzie developed the McKenzie Method for classifying and treating spinal disorders7
classified disorders as either postural, dysfunction, or derangement
derangement is most common and involves "centralizing" the pain
focus on education and actively involving the patient in the treatment
an example of a McKenzie technique is shown in the following video:

Epidural steroid injection: steroids are injected directly into the level of the lumbar spine where the herniation is present
provides a short-term reduction of inflammation
usually performed if other conservative treatments have not been effective
successful in 42%-56% of patients1
Modalities
In addition to other conservative treatments, there are also several modalities that can be included in treatment for lumbar herniated discs. These include:

Mechanical traction
Ultrasound
Low-Power Laser
While these are proven to decrease symptoms associated with lumbar herniated discs, they should not soley be used as treatment.

Surgical Treatment
Microdiscectomy: most common surgical procedure for herniated lumbar discs9
removes the piece of the disc and any other fragments that are compressing on the spinal nerve
more effective in relieving leg pain associated with the herniated disc than back pain
successful in relieving leg pain in >90% of patients

Footnotes
1. American Academy of Orthopedic Surgeons. Lumbar Disk Herniation. http://orthoinfo.aaos.org/topic.cfm?topic=A00534. Updated February 2009. Accessed November 16, 2010.
2. Abibol J, Dawson E, Haid R. Lumbar Herniated Disc. http://www.spineuniverse.com/conditions/herniated-disc/lumbar-herniated-disc. Updated May 18, 2010. Accessed November 16, 2010.
3. Mayfield Clinic. Herniated lumbar disc. http://www.mayfieldclinic.com/PE-HLDisc.htm. Updated April 2009. Accessed November 16, 2010.
4. Ullrich P. Lumbar Herniated Disc. http://www.spine-health.com/conditions/herniated-disc/lumbar-herniated-disc. Updated July 22, 2009. Accessed November 16, 2010.
5. MedlinePlus. Herniated disk. http://www.nlm.nih.gov.proxymu.wrlc.org/medlineplus/ency/article/000442.htm. Updated May 25, 2010. Accessed November 16, 2010.
6. Humphreys S, Eck J. Clinical Evaluation and Treatment Options for Herniated Lumbar Disc. http://www.aafp.org/afp/990201ap/575.html. Updated February 1, 1999. Accessed November 16, 2010.
7. The McKenzie Institute International. The McKenzie Method. http://www.mckenziemdt.org/approach.cfm?section=int. Updated 2010. Accessed November 23, 2010.
8. Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. J Manipulative Physiol Ther. 2008;31(3):191-198.
9. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA. 2006;296(20):2441-2450.
10. North American Spine Association. Herniated Lumbar Disc. http://www.spine.org/Documents/herniated_lumbar_disc_2006.pdf. Updated 2006. Accessed November 16, 2010.
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09/07/2025

Say goodbye to pain and hello to freedom of movement! 🌟 At Shammahphysiotherapyandchiropracticcentre Kakamega got you , we help you recover faster, move better, and live life to the fullest. From sports injuries to everyday aches, our expert physiotherapists have your back (and knees, shoulders, and more!). 💪✨ Book your session today! Visit us at Avenue Healthcare kakamega, along Sudi road.

09/07/2025

🌟 Say goodbye to pain and hello to freedom of movement! 🌟 At shammah, we help you recover faster, move better, and live life to the fullest. From sports injuries to everyday aches, our expert physiotherapists have your back

19/02/2025

We value your health, kindly find us at this locations in kakamega and athiriver

19/10/2024

Sponylosis
Definition

Spondyloarthropathies are a group of disorders which are considered to be variants of Rheumatoid Arthritis (RA). Ankylosing Spondylitis (AS) is one of the spondyloarthopathies which affects various joints of the axial skeleton.1

Anatomy

AS can occur in individuals in various places of the body. The major places of incidence with AS include: sacroiliac joints, apophyseal joints, costoveterbral joints, and the intervertebral disc articulations.1 In as many as 33% of cases of AS, individuals have been known to have unilateral symptoms of peripheral joints.

Figure above shows areas affected by Ankylosing Spondylitis1

Incidence/Prevalence

Ankylosing Spondylitis (AS) affects approximately 0.1 -0.2 percent of the general population of the United States. AS is more common in Caucasians and Native Americans than other ethnic groups. AS has been found to be more prevalent in males than females. Typically, AS is found to affect individuals between the ages of 15 and 30 years of age; however, it can be found in individuals after age 40, but these cases are rare.1

Potential Etiologies

The literature states there is no known cause for AS or any of the other spondyloarthropathies; however, there is evidence in support of genetic factors. 90% - 95% of individuals who are diagnosed with AS are positive for HLA-B27 and also individuals who are positive for HLA-B27 are at an increased risk of developing AS.2 The chances of an individual developing AS becomes substantially higher if an immediate family member is positive for HLA-B27. Other causes of the development of AS (also other spondyloarthropathies) researched is the interaction of bacteria and HLA-B27, and the overexpression of TNF. Even though there is a genetic influence on those who are diagnosed with AS, it has been found that that disease is not sex-linked. Although the disease seems to be more prevalent in males, it is hypothesized that women may have milder forms of AS, resulting in the disease being underdiagnosed in women.1

Clinical Presentation

One of the chief complaints of inidviduals diagnosed with AS is low back pain. The pain sensation is due to the inflammation of the sacroiliac joints and possible other areas of the axial spine. Other symptoms of As are spinal stiffness and loss of mobility, both can be caused by the inflammation. Some individuals may have involvement of the hip and shoulder with AS. When the hip is involved during the progression of the disease, it is viewed as a bad sign for prognosis; however, there is no definite measure of the severity of the disease.2

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Karibuni

A well equipped physiotherapy clinic. We offer treatment to illnesses that adversely affect normal body movements.
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Get us at shivas arcade and avenue healthcare kakamega